Hysteria (Hysterical Conversion Disorder)
In everyday language hysteria refers to any emotional extreme. For example, an episode of hysterica, weeping or laughter. When used medically, the word refers to a disorder, formerly called hysterical neurosis, in which unconscious psychological conflict is transformed into physical, or somatic, symptoms.
The most common conversion symptoms suggest a neurological disorder, such as paralysis, seizures, blindness or tunnel vision, deafness, or an inability to smell, feel, or speak. Symptoms may appear to originate in the endocrine system, for example, a false or hysterical pregnancy. In one form, called globus hystericus, the person has difficulty swallowing because of a nonexistent lump in the throat. Vomiting and fainting can also be expressions of a conversion disorder. In some cases, symptoms are brought on by extreme psychological stress. In hysterical amnesia, for example, loss of memory is a way of suppressing events that are too painful to recall,
Psychiatrists cite two subconscious mechanisms that seem to be involved in hysterical conversion reactions. One is avoidance of psychological conflict. For example, a sudden inability to hear or speak may follow an intense argument and reflect the person's inability to otherwise confront his anger. The other is avoidance of a dreaded activity.
Examples include the child who vomits when it is time to set off for school or the soldier who suddenly goes blind, exempting him from battle.
Diagnostic Studies and Procedures
Before making a diagnosis of hysteria, a thorough medical workup that includes a complete physical examination, blood and urine studies, and a neurological evaluation is needed. Additional tests depend on symptoms, but may include CT scans or MRIs and other imaging studies to rule out an organic cause, such as a stroke or tumor. If hysteria is suspected, then psychological testing is in order. Once a doctor determines that the problem is psychological, hypnosis may be used to search for the underlying emotional cause.
Medical Treatments
An attack, or fit, of hysterics, in which the individual alternates between uncontrolled crying and laughter, is usually treated with a sedative or tranquilizer. This loss of control is generally triggered by an emotional trauma and is unlikely to become chronic.
Some psychiatrists prescribe tranquilizers during treatment of chronic conversion disorder, but psychotherapy is the main approach. Although this is lengthy, it usually produces results because it helps patients come to terms with the underlying emotional cause for physical symptoms. Dream analysis may play a role in treatment. In some cases, short-term goal-oriented therapy may suffice, especially if there is a clear link between the symptoms and their psychological cause.
Alternative Therapies
Alternative therapies can help patients confront experiences and memories that they have buried.
Art Therapy. An art therapist can guide a patient in recreating scenes from childhood or in making sketches that express hidden feelings. Combined with psychotherapy, this approach can be highly beneficial.
Hypnosis. During hypnosis, some patients have been able to recall and eventually come to terms with the circumstances that led to their physical symptoms. This technique has been especially useful in helping adults overcome psychological problems stemming from childhood sexual abuse and other traumatic or frightening events.
Self-Treatment
A conversion disorder is unlikely to be resolved by self-treatment without the help of a mental-health professional. Individuals suffering from hysteria are too willing to take all kinds of medicines, and even to undergo surgery, for nonexistent illnesses. Family members and friends should discourage this behavior. Although they might try to be sympathetic and listen to complaints, they should encourage the person to seek professional help.
Other Causes of Hysteria Symptoms
Many specialists find it difficult to establish clear boundaries between hysteria and other psychological problems, including hypochondria, anxiety, panic attacks, phobias, and depression. Some are convinced that chronic fatigue syndrome and severe multiple allergies-two prevalent disorders that lack any identifiable physical cause—are manifestations of a conversion disorder.
In addition, a number of organic diseases produce symptoms that may be attributed to a conversion disorder. These include multiple sclerosis, systemic lupus erythematosus, and various neurological diseases.